Minimally invasive corpectomy and posterior stabilization for lumbar burst fracture

Abstract OBJECTIVE To demonstrate the feasibility of and initial clinical experience with a novel minimally invasive posterolateral thoracic corpectomy technique. METHODS Seven procedures were performed on 6 cadavers to determine the feasibility of thoracic corpectomy using a minimally invasive approach. The posterolateral thoracic corpectomies were performed with expandable 22 mm diameter tubular retractor paramedian incisions. The posterolateral aspects of the vertebral bodies were accessed extrapleurally, and complete corpectomies were performed. Intraprocedural fluoroscopy and postoperative computed tomography were used to assess the degree of decompression. In addition, 2 clinical cases of T6 burst fracture, 1 T4–T5 plasmacytoma, and 1 T12 colon cancer metastasis were treated using this minimally invasive approach. RESULTS In the cadaveric study, an average of 93% of the ventral canal and 80% of the corresponding vertebral body were removed. The pleura and intrathoracic contents were not violated. Adequate exposure was obtained to allow interbody grafting between the adjacent vertebral bodies. The procedures were successfully performed in the 4 clinical cases using a minimally invasive technique, and the patients demonstrated good outcomes. CONCLUSION Based on this study, minimally invasive posterolateral thoracic corpectomy safely and successfully allows complete spinal canal decompression without the tissue disruption associated with open thoracotomy. This approach may improve the complication rates that accompany open or even thoracoscopic approaches for thoracic corpectomy and may even allow surgical intervention in patients with significant comorbidities.

Download Full-text

Percutaneous iliac screw placement: description of a new minimally invasive technique

Neurosurgical FOCUS ◽

10.3171/foc/2008/25/8/e17 ◽

2008 ◽

Vol 25 (2) ◽

pp. E17 ◽

Cited By ~ 39

Author(s):

Michael Y. Wang ◽

Steven C. Ludwig ◽

D. Greg Anderson ◽

Praveen V. Mummaneni

Keyword(s):

Minimally Invasive ◽

Burst Fracture ◽

Spinal Instrumentation ◽

Screw Placement ◽

Invasive Technique ◽

Invasive Approach ◽

Spinal Stabilization ◽

Future Studies ◽

The Past ◽

Iliac Screw

Minimally invasive spinal instrumentation techniques have evolved tremendously over the past decade. Although there have been numerous reports of lumbar instrumentation performed via a percutaneous or minimal incisional route, to date there have been no reports of minimally invasive iliac screw placement. A method was developed for accurate placement of minimally invasive iliac screw placement based on a modification of currently available percutaneous lumbar instrumentation techniques. The method involves fluoroscopically guided insertion of a cannula-based screw system, and this technique was successful applied to treat an L-5 burst fracture with L-4 to iliac spinal stabilization via a minimally invasive approach. This report demonstrates the feasibility of percutaneous iliac screw instrumentation. However, future studies will be needed to validate the safety and efficacy of this approach.

Download Full-text

A Rare Case of Contiguous Three-level Lumbar Burst Fractures-treated with Combined Posterior Stabilization and Anterior Fusion

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i02.2032 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Charanjit Singh Dhillon ◽

Ahamed Shafeek Nanakkal ◽

Nilay Prafulsinh Chhasatia ◽

Narendra Reddy Medagam ◽

Anandkumar Khatavi

Keyword(s):

Lumbar Spine ◽

English Literature ◽

Burst Fracture ◽

High Energy ◽

Individual Characteristics ◽

Neurological Deficits ◽

Surgical Approaches ◽

Anterior Fusion ◽

Posterior Stabilization ◽

Burst Fractures

Introduction: Burst fractures occur frequently in high energy trauma and are commonly associated with falls from height and road traffic accidents. While multiple burst fractures are not uncommon in thoracic spine, three or more contiguous level burst fractures are a relative rarity especially, in lumbar spine. The treatment of multilevel burst fractures must be individualized, and each fracture should be treated according to its inherent stability. To the best of our knowledge, this is the only case of such injury reported in English literature. Case Report: A 17-year-old girl who sustained contiguous three-level lumbar burst fractures with neurological compromise following alleged history of fall from height. Radiographs/computed tomography scan revealed burst fractures of L2, L3, and L4 vertebrae with retropulsion of bony fragments at all the levels. Patient underwent minimally invasive posterior stabilization and anterior Hemi-corpectomy of L2, L4, and fusion. The patient recovered completely from neurological deficits by the end of 6 months. Conclusion: Multiple contiguous burst fractures in the lumbar spine are a rare entity. To the best of our knowledge, this is the only case of such injury reported in English literature. The treatment requires a thorough assessment of the fracture pattern and often requires a combination of surgical approaches. Each fracture merits treatment based on individual characteristics of fracture patterns and the amount of canal compromise at each level. Keywords: Lumbar, burst fracture, multiple, contiguous.

Download Full-text